CARE HOME ADULTS 18-65
The Gables 262 Ipswich Road Colchester Essex CO4 0ER Lead Inspector
Deborah Kerr Unannounced Inspection 16th April 2008 09:00 The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Gables Address 262 Ipswich Road Colchester Essex CO4 0ER 01206 841515 01206 841515 manager_gables@careaspirations.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Aspirations Limited Raymond Gilbey Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 7 persons) One person, over the age of 65 years, who requires care by reason of a learning disability, whose name was made known to the Commission in January 2004 The total number of service users accommodated in the home must not exceed 7 persons 19th April 2007 Date of last inspection Brief Description of the Service: The Gables is a detached, two-storey house on the busy Ipswich Road in Colchester. There is parking for three vehicles at the front of the property. A keypad entry system is in operation. Each person has their own fully en-suite bedroom, with either bath or shower. Communal areas consist of a lounge and a conservatory extension, which also serves as a dining room. There is also a large, enclosed garden to the rear of the house. The home is registered for seven people with a learning disability. The home was purposely set up for seven people as a friendship group, who with the exception of one individual have previously lived together for many years in a larger home within the organisation. The Gables offers people a quieter and more ordinary home life. The weekly charge for a room at The Gables is between £879.81 and £1435.32. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. An extra charge is made for hairdressing, toiletries and chiropody. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The inspection was unannounced on a weekday, which lasted six and three quarter hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from four relatives and eight staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home and two members of staff. The manager of the home and the assistant director of Care Aspirations were available during this inspection and fully contributed to the inspection process. What the service does well:
The Gables has modern facilities, with good sized rooms, which are personalised, pleasantly decorated and well maintained. When entering the home there is a friendly, happy and relaxed atmosphere. The staff team has worked at The Gables for a long period of time, providing stability and continuity for the people living there. Staff were able to demonstrate a good understanding of the particular needs of each person. Overall the outcomes for people living in the home are positive, they are provided with opportunities to make choices and are supported to do what they want to do, allowing them to be as independent as they can be. Feedback about the service, provided in relatives and staff surveys and through conversations with people living at the home was positive. Comments included “The Gables provides a happy caring environment for the clients” and “I am very pleased about everything at the home, my relative is very happy there. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
A previous requirement was made for care plans to be reviewed at least every six months. Although there was evidence that people’s care plans are being reviewed, they did not reflect their current needs. Additionally, it was previously recommended that care plans should be further developed using a more person centred approach. This has not yet happened, however staff are in the process of receiving training for person centred planning. Care plans would be more meaningful and interesting to the people who use the service, if they were involved in the development of their care plan, using (where appropriate) a similar easy read format to the service user guide. To safeguard the people living at the home a previous requirement was made for all recruitment checks to be obtained before employing staff at the home. Examination of staff files identified, a member of staff only had one reference, instead of the two required. Where records are held at head office, it was not possible to ascertain the date a staff’s Criminal Records Bureau (CRB) check, was received. The Protection of Vulnerable Adults (POVA) first was requested after the individuals start date, which reflects that the staff member had commenced employment before all documentation was received. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 7 A previous recommendation was made for cushion covers on the lounge suite to be replaced as these had shrunk with frequent laundering, this continues to be a problem and still need to be replaced. The complaints and safeguarding policies and procedures need to be amended to reflect the change in the contact details of the Commission for Social Care Inspection (CSCI). Where ‘have your say surveys’ identified that not all people are aware of how to make a complaint, information should be made available to relatives reminding them of how and who to complain to should the occasion arise. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5. People who use the service experience good quality outcomes in this area. People considering moving into the home and their representatives will be provided with information, which clearly tells them about the service and enables them to make a choice about whether their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care Aspirations have developed a comprehensive statement of purpose and Service Users Guide, which are specific to the people who use this service. Three people were tracked as part of the inspection process. Two out of the three people had been issued with their own Service User Guide, which contains the ‘How to Complain’ procedure and their terms and conditions (contract) of occupancy. The third person had transferred from another home within the organisation and had not yet been given a copy. The information is provided in an easy read format with appropriate language and pictures. These had been discussed, agreed and signed and dated by the individual or a relative, on their behalf. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 10 Examination of three care plans confirmed assessments are in place, which covered the main needs and risks experienced by each person. There has been one admission to the home since the last inspection, however the individual had transferred from another home within the organisation and therefore no new needs assessment had been completed. The home’s certificate of registration was seen on display in the entrance hall. This reflects the home is registered to provide care to one individual over the age of 65. Information provided in the AQAA and confirmed at the inspection, is that another person living at the home is now over the age of 65. The manager was advised the statement of purpose and service user guide will need to be amended to reflect the age range of the people living in the home. They will also need to demonstrate they can continue to meet the individual’s needs. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. People who use the service experience adequate quality outcomes in this area. Although, staff were able to tell us all the ways they need to support people living in the home, individuals are not currently involved in planning the care and support they receive to ensure that their individual needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of three care plans confirmed each contained a current photograph of the individual together with their personal details, including next of kin and other important contacts. Each person has a detailed pen picture providing a good account of their past, physical and mental health, personality and behaviours. A previous recommendation was made for care plans to be reviewed regularly to ensure these are kept up to date. There was some evidence that plans had been reviewed, however the plans contain a lot of information, including previous plans about the individual’s health, personal and social care. The information does not reflect people’s current needs and state of health.
The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 12 The care plan of an individual still had support plans made at their previous home. These conflicted with plans agreed at The Gables, for example, the pen profile and Primary Care Trust (PCT) assessment, refers to the individual’s previous history of inappropriate behaviours. The care plans and risk assessments make reference to the individual going out unsupervised. Other legal information states the individual needs to be accompanied when going out. Staff spoken with confirmed that the individual is always supported when out in the community. Although, information in the care plans is not up to date, discussion with staff confirmed that they have a very good understanding of each of the individuals needs and were able to tell us all the ways people need to be supported. Pen pictures and risk assessments seen in care plans gave detailed information where certain circumstances would cause individuals distress, which could lead to inappropriate behaviours. It was also noted that protocols for the use of PRN (as required) medication are in place, which identified non-drug methods of reducing agitation, for example one to one support, going for a walk or making a cup of tea. However, the risk assessments do not identify the action staff should take to ensure that physical and/or verbal aggression and unpredictable behaviours are dealt with appropriately. The assistant director of Care Aspirations and the manager confirmed that risk management training is currently in progress to ensure that risk assessments are completed with individualised procedures for dealing with challenging behaviours. They also provided a training pack, purchased by the organisation, which includes 18 modules, covering all aspects of working with people with learning difficulties. These include an introduction to mental health, challenging behaviour, psychiatric disorders and mental health problems. Observation during the day confirmed individuals are involved in making some decisions regarding day to day living and social activities. A previous recommendation was made for people living at The Gables to have a say about matters that significantly affect their lives. Arrangements have been made with Tendering Independent Advocacy Service to visit throughout the year on a monthly basis to hold surgeries and facilitate residents meetings. A schedule of dates was seen, accompanied by a brochure produced by the advocacy service providing information about them in an easy read format, with photos of each of the advocates. They have made introductory visits to The Gables to meet and get to know the people living there, before they commence surgeries. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. People who use the service experience good quality outcomes in this area. People who use this service are supported to make choices about their lifestyle and take part in social and recreational activities, which meet their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous recommendation was made for people living in the home to have activity plans that address their diversity and which lead to their personal development and fulfilment. Previously, activity plans showed that scheduled activities were subject to a number of variables, such as the availability of staff and the needs of others living at the home. Activity plans, have been tailored to the individual and reflect how they spend their time, however there is no record to confirm that these activities take place. Discussion with people using the service and observation during the inspection confirmed that increased staffing ratio’s have led to people pursuing activities of choice rather than ‘fitting in with the service’.
The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 14 People were supported on a one to one basis to walk to Highwood’s to go shopping at different stages during the morning. Five people chose to go out for a drive to the coast and to a pub for an afternoon drink, another chose to stay at home to do some work on their computer and another individual was escorted via public transport to a hospital appointment. Discussion with people using the service confirmed they were happy with the service they received and talked of holidays, outings and activities they are involved in. One person spoke of their plans to go swimming that evening at a local school. Observation and records showed that people had freedom to move around the home and could choose to be alone and whether to help with housekeeping tasks. Care plans confirmed that people living in the home continue to have regular contact with family and the people who matter to them. An aerobics instructor was observed co-ordinating an armchair exercise session. All, but one person living in the home chose to take part and clearly enjoyed and benefited from the workout. The instructor has been visiting the service on a regular basis for approximately six years and knows the people and staff at the home well. They described the service as excellent, always clean and tidy and although the people living at the home can be quite challenging they have never witnessed poor practice by the staff team and is impressed at how well the home is managed. A previous requirement identified that people living in the home should have a more balanced diet. Inspection of the kitchen, menus and nutrition records confirmed there has been significant improvement in this area. Kitchen cupboards, fridges and freezers were stocked with a range of fresh and frozen foods, vegetables and fruit. The choice of menu checked against the nutrition records confirmed meals are more varied and include fresh fruit and vegetables. Records included the occasional take away, such as fish and chips. Nutrition records also list where people have extra snacks and drinks throughout day. The lunchtime meal was observed, which consisted of steak pie, chips, peas, carrots and sweet corn, followed by a choice of yogurt, Muller rice or jelly, in a variety of flavours. The mealtime was a relaxed and social occasion. People were observed discussing with staff how they wanted to spend the afternoon. Only one individual required some encouragement and assistance to eat their meal, this was done sensitively and respectful of individual’s dignity. Several attempts have been made by the manager for a dietician to visit the home for advice on providing balanced diets, particularly for one individual who has health problems. The dietician has not yet visited the service, but has discussed issues over the phone, confirming that staff are providing a balanced diet, if they are including the recommended five portions of fruit and vegetables a day. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. People who use the service experience adequate quality outcomes in this area. Although staff are aware of the individual needs of people using the service, the variable practice regarding planning and recording peoples health needs, means that they cannot be sure that their health needs will be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that people living in the home are supported to have access to health care services. Dates and details of appointments are clearly recorded on a health appointment sheet. Observation and discussion with staff confirmed that they are fully aware of the individual needs of people using the service and were able to provide a verbal account of each person’s health and well being, however, the information in the care plans did not reflect this. Each of the people living in the home has their own health plan booklet. Some elements of the booklets were incomplete, for example the section ‘About Me’ was blank, however this was described fully in the pen picture within the care plan.
The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 16 Both the health plan and care plans have significant gaps in information and do not reflect the individual’s current health. For example, an individual’s health appointment sheet reflected they had been to hospital on two occasions in January this year, for treatment to investigate ongoing health issues. There was no outcomes or results of these visits recorded. Staff spoken with were unaware of feedback about the person’s condition or if further treatment was required. Additionally, the health plan booklet has a significant health related section, this had not been completed for an individual whose poor health was described during the inspection. Care plans contained letters from health professionals setting out plans to support individuals to take control and manage their own health care. However there were no plans in place to evidence that these plans were being followed. For example, a report from a continence advisor recommended a toileting plan for an individual to manage their continence. There was no plan in either the care plan or health plan to reflect a programme is in place or how this was being managed. Although, the staff currently working in the home are aware of the health needs of each person, more could be done to accurately record information to provide an overview of the individuals current state of health. Where information is being recorded, there needs to be consistency of information to prevent confusion, either in the health plan or the care plan. This will ensure information is correct and up to date. Examination of the care plans reflects that staff are completing weekly charts to show that all aspects of personal care and hygiene have been met. People are assisted with personal care in the privacy of their own en suite bathrooms. The home has no communal toilet or bathing/showering facilities. Observation and discussion with staff confirmed they are aware of the need to treat people with respect and dignity when delivering personal care. All people living in the home were appropriately dressed and well presented on the day of inspection. The home has efficient and comprehensive medication policy and procedures in place for ordering, storing, administering and disposal of medicines. The practice of administering medication is generally safe and well managed. Medication Administration Records (MAR) were inspected and were found to be completed correctly, with no gaps. Staff had made good use of the reverse of MAR to reflect when PRN (as required) medication had been given and the amount. Individual photographs were attached to the records to avoid mistakes with the person’s identity. Previous recommendations were made for a list to be held at the front of the MAR charts folder of staff authorised to administer medication and their sample signatures, as they would appear on the MAR charts. This is so it could be easily determined, who had administered medication at any one time. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 17 Additionally, it was previously recommended that a list of each persons current medication be kept reflecting the frequency and dose, which could be cross referenced with the MAR charts and as a means of checking that each person was receiving their correct medication. Both of these recommendations have been implemented. The MAR folder also contained protocols in respect of PRN medication. These provided guidance for staff when they should use PRN medication. It was noted that these protocols appropriately highlighted alternatives to drug intervention. Medication is locked in a proper metal storage cupboard within a locked cupboard to which only seniors hold the key. Limited stock is held. The returns medication book was seen, with a list of medications, including the date and reason why it was being returned. This had been countersigned by the pharmacist. Two staff were observed administering the lunchtime medication. The second member of staff acts as a witness to ensure the correct dose is given and medication is signed as given. Discussion with staff and training records confirmed staff have received training in first aid and the administration of medicines. The health plan has a section titled ‘my future as I get older’ which relates to death and dying. A record of the individuals wishes had been recorded “I would like to stay where I am, my family will help me plan my funeral arrangements”. Additionally, care plans have a terminal illness, death and dying plan in place. The plan states the individual wants to be made comfortable and free of pain and that staff need to comply with the individuals and relatives wishes, and in accordance with instruction by medical professionals. A tour of the environment confirmed the home has aids and equipment to encourage maximum independence and comfort for the people living in the home. These include walk in baths, grab rails and hoists. Where an individual is assessed as a high risk of occurring pressure areas they have been provided with a pressure relieving mattress and cushion in for their wheelchair. Records seen confirmed the equipment is regularly serviced to ensure they are in good working order. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People who use the service experience good quality outcomes in this area. People who use this service have access to a robust and effective complaints and safeguarding procedures, which protect them from abuse, neglect and self harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home has a clear and effective complaints procedure and an appropriate adult safeguarding policy in place, which includes clear guidance of the procedures staff must take to report allegations of abuse. These will need to be amended to reflect the change in the contact details of the Commission for Social Care Inspection (CSCI). The complaints, comments and suggestions procedure describes the stages of making an informal and formal complaint. The service user guide includes an easy read and pictorial format of ‘How to complain’. Additionally, it was noted that each person had a flash card in their rooms ‘Don’t be bullied’ with bullet points of what to do if someone was unkind to them. The complaints log identified that there has been one complaint made about the service since the last inspection. The complaint was dealt with in accordance with the procedure, which was open and constructive and completed within the given timescales. Staff spoken with are aware of residents rights and how to refer a complainant to a senior member of staff. They were clear about their duty of care and what they would do if they had concerns about the welfare of a resident.
The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 19 However, information obtained in ‘have your say surveys’, reflects that not all relatives are aware of how to make a complaint. A previous requirement was made for staff to have training they need to protect people living at the home, and for their own protection. Information provided in the AQAA and verified at the inspection, confirms that all staff have attended safeguarding adults training provided by Essex County Council. The manager has also completed a train the trainer course and has a resource pack to provide in house refresher training. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30. People who use the service experience good quality outcomes in this area. The physical layout and design of the home enables people to live in a safe, wellmaintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that The Gables provides comfortable and warm accommodation, which is well maintained to a good standard and provides a homely atmosphere. Communal rooms are spacious and well furnished with modern equipment and domestic style furniture, carpets and curtains. A recommendation was made previously for cushion covers on the lounge suite to be replaced as these had shrunk with frequent laundering, this continues to be a problem and still need to be replaced. The premises are bright, cheerful, airy and free from any unpleasant odours. The Gables has it’s own garden and has good access to the local community and facilities. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 21 There is a selection of communal areas, consisting of a small kitchen, lounge and a conservatory, which doubles up as a dining room. The conservatory has French windows, leading out into a large rear garden, which backs on to Highwood’s Park. Issues were raised previously about the conservatory being used for staff training, which impacted on people having access to all parts of the home. To resolve this issue a summerhouse has been erected in the garden, and is now used for training purposes. All bedrooms are suitable for the needs of their occupants with spotlights, safe radiators, full en suite facilities, individual bedding and colour schemes. Personal effects reflect people’s hobbies and interests, including artwork, an exercise bike and a collection of soft toys. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when washing their hands, taking a bath or shower. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding, including a commercial washing machine with a sluice programme for dealing with soiled linen. Appropriate hand-washing facilities of liquid soap and towels are situated in all en suite facilities where staff may be required to provide assistance with personal care. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. People who use the service experience adequate quality outcomes in this area. Staff are trained, skilled and in sufficient numbers to support the people who use this service, however people living in the home are not currently protected by the home’s recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous inspection reflected the ratio of staff to service users was adequate to meet people’s needs and provide some person-centred care, but was not sufficient for the one-to-one support people needed for individually tailored activities. Discussion with staff and examination of the staff duty roster confirmed that an increase in ratio of staff has led to improved activities. This was observed during the inspection, with people making choices of how they wanted to spend their time. Two members of staff have transferred from other Care Aspirations homes, plus an additional member of staff has been recruited. The roster reflects staffing ranges between three to five staff daily, during the week. On the day of the inspection there were three staff on duty, between 8am – 9.30pm, plus the manager, with two waking night staff between the hours of 9pm – 8.30am.
The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 23 Staff spoken with confirmed staffing levels are good, there are plenty of staff to assist with indoor and outdoor activities. Staff are able to split up to meet peoples needs, which has included more one to one activities of choice, such as going into town shopping. This was confirmed in discussion with people living in the home. The AQAA identified that full staff checks are carried out prior to appointment to safe guard the people living in the home. However, staff files examined identified that not all the relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to commencing employment. One of the staff files only had one reference, instead of the two required. The manager contacted the head office to request the second reference, however this could not be located. Additionally, only the top section of the staff’s Criminal Records Bureau (CRB) check and disclosure number was available, which does not show the date the CRB was received or if any convictions were identified. It was therefore not possible to ascertain the date that the staff’s CRB check, was received. Also the Protection of Vulnerable Adults (POVA) first was requested after the individuals start date, which reflects that the staff member had commenced employment before all documentation was received. Recruitment practices and documentation were discussed with the manager and assistant director. Most recruitment information is held on site, however, the assistant director advised personal information is held at the human resources department. If any convictions are identified on CRB’s, these are investigated and risk assessed, after which a decision is made whether to employ the individual based on advice from the company’s legal advisor. Eight staff ‘have your say’ surveys were received prior to the inspection. These confirmed that staff felt they had been recruited fairly, received support and training, so that they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Care Aspirations have introduced their own induction training programme, which meets the requirements of the Skills for Care Induction Standards. Informaton in staff files confirmed that new employees had completed the induction training. A previous recommendation was made for records of training to be kept, to provide evidence of the skills and competencies achieved by staff. Each member of staff has an individual development plan, which is now computerised and reflects training completed and planned. This is discussed as part of the supervision process and outlines their roles and responsibilities and identifies new training needs. Most recent training has included person centred planning, advocacy, food hygiene, risk assessment and risk management, fire safety, moving and handling and safeguarding adults. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 24 Staff responsible for administering medication have received training to use the Monitored Dosage System (MDS) and about drugs and common side effects. Further training has been planned using a training pack purchased by the company. A company nurse will provide the training, which covers all aspects of working with people with learning disabilities. Each module will be individually certificated. Information provided in the AQAA and verified at the inspection confirmed that Care Aspirations continue to provide staff with the opportunity for completing National Vocational Qualification (NVQ). The home employs thirteen staff, nine have completed NVQ Level 2 or above, with one currently working towards completion. These figures reflect that the service has reached the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Records indicated that regular supervision is now taking place, this was confirmed in conversation with staff. The content of these meetings was relevant to people’s roles at The Gables. Documentation reflects that sessions include discussion of general work objectives, performance and development and identify training needs. Additionally staff felt the manager was very supportive and was always available, if issues or problems arise. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42. People who use the service experience good quality outcomes in this area. People living at The Gables benefit from an efficiently run home, which is based on openness and respect and monitored and improved through an effective quality assurance system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the registered manager has the required qualifications and experience and is competent to run the home. The manager completed the AQAA when we asked for it, which provides clear and relevant information. The AQAA informed us about changes that have been made to improve the service and identifies where improvements need to be made and how these are to be implemented. Although, the manager has overall responsibility for the service, there are clear lines of accountability and delegation of duties within the staff group. Staff confirmed they have regalar staff meetings and have the opportunity to share in the way the service delivery is planned and actioned.
The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 26 Care Aspirations continued to have suitable processes in place for monitoring the quality of care at The Gables, including a monthly audit of the service, undertaken by another manager within the organisation and a separate monthly monitoring visit from the Responsible Individual. An independent consultant has been sourced to survey the views of people living at the home and to identify where the service needs to improve. The assistant director agreed to forward a copy of the outcomes of the survey to the CSCI. Records examined at the inspection and information provided in the AQAA confirmed the home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that all equipment including the fire alarm system and emergency lighting and hoists are regularly checked and serviced. The home’s maintenance folder contained appropriate procedures and provided evidence of routine, internal monitoring of systems to ensure compliance with health and safety requirements (such as checking the temperature of hot water in individual bedrooms, flushing showerheads through weekly and monitoring records for food safety). Fridge temperatures are being recorded and the temperature at which food is served, in line with food safety standards. Care plans contained detailed incident and accident report forms, the recording on the forms is good with detailed information about the incident. These are reviewed by the manager to assess how further incidents can be avoided. A previous recommendation was made for environmental risk assessments to be reviewed annually to take account of changing circumstances and needs. These assessments were not reviewed as part of the inspection and will be looked at in detail at the next visit. People who use the service are supported to obtain, secure and spend their personal money. Each person has access to small amounts of money to purchase personal items. This is held in a safe in the office. All other monies belonging to people living in the home are held and managed centrally at head office, including their personal allowance and Disability living allowance (DLA). The company provides an annual allowance to each individual for an annual holiday, clothing allowance and a Christmas and birthday gift. Only the manager and senior staff have access to people’s money held on site. Cash control sheets are kept providing a record of the date, details of any transaction and staff signature involved in the transaction. Receipts are obtained all purchases. The cash sheets and balance of two peoples monies were checked and found to be accurate. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 4 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 3 3 3 X 3 3 3 The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 Requirement Each person living in the home must be provided with a copy of terms and conditions of residence (contract), which sets out the amount, and method of payment of fees. This will ensure people living in the home know what services are provided and what they must do. Timescale for action 29/05/08 2. YA6 15 29/05/08 After consultation, with the service user a care plan must be written as to how the person’s needs in respect of their health and welfare are to be met. The plan must be available to the individual and kept under review. This will ensure that people living in the home will have their needs and wishes kept up to date and conveyed to other staff. Where some people living in the home have been identified through risk assessment of presenting behaviour that can be challenging to others, training and risk management strategies need to be agreed for staff to appropriately support the
DS0000028587.V362572.R01.S.doc 3. YA9 13 (6) 29/05/08 The Gables Version 5.2 Page 29 individual. This will ensure that staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others. 4. YA19 12 Care plans should be reviewed at 29/05/08 least every six months to identify people’s changing needs. This will ensure that the people living in the home will receive support that promotes and make proper provision for their care, health and welfare. Before employing staff the home must obtain all the documents and records that are required to protect residents from people who should not be working with them. This is a repeat requirement from the previous key inspection 19/04/2007. 29/05/08 5. YA34 17 Sch 4 19 Sch 2 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA42 Good Practice Recommendations Risk assessments should be reviewed and updated at least annually to protect residents and staff. The Gables DS0000028587.V362572.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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